International Journal of COPD (Sep 2020)
Evaluation of Medication Adherence and Rescue Medication Use in Non-Exacerbating Patients with COPD Receiving Umeclidinium/Vilanterol or Budesonide/Formoterol as Initial Maintenance Therapy
Abstract
Chad Moretz,1 Ashley L Cole,2 George Mu,2 Benjamin Wu,1 Amy Guisinger,1 Yunhao Liu,2 Beth Hahn,1 Lee Baylis3 1US Value Evidence & Outcomes, GlaxoSmithKline, Research Triangle Park, Durham, NC, USA; 2VEO Data, Methods, and Analytics, GlaxoSmithKline, Collegeville, PA, USA; 3US Medical Affairs, GlaxoSmithKline, Research Triangle Park, Durham, NC, USACorrespondence: Beth HahnGlaxoSmithKline, 5 Moore Drive, Research Triangle Park, Durham, NC, USATel +1 919 274 0660Email [email protected]: Adherence to inhaled maintenance therapy is critical to managing chronic obstructive pulmonary disease (COPD), while increasing rescue medication usage may indicate worsening symptoms. This study evaluated adherence and rescue medication use in patients with COPD without a history of exacerbation who initiated combination therapy with budesonide/formoterol (B/F) or umeclidinium/vilanterol (UMEC/VI).Methods: Retrospective observational study of commercially insured and Medicare Advantage with Part D enrollees who initiated UMEC/VI or B/F between January 1, 2014 and December 31, 2017 (earliest fill defined as index date). Eligibility criteria included age ≥ 40 years, 12 months continuous enrollment pre- and post-index, ≥ 1 pre-index COPD diagnosis, no pre-index asthma diagnosis, COPD-related exacerbations, or medication fills containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists. Inverse probability of treatment weighting (IPTW) was used to balance treatment groups on potential confounders. Medication adherence (primary endpoint) was evaluated by the proportion of days covered (PDC). Rescue medication use (secondary endpoint) was standardized to canister equivalents (1 metered dose inhaler [200 puffs] or ∼ 100 nebulized doses of short-acting β2-agonist- and/or short-acting muscarinic agonist-containing medication).Results: After IPTW, covariates were balanced between cohorts (UMEC/VI: N=4082; B/F: N=9529). UMEC/VI initiators had a significantly greater mean PDC (UMEC/VI: 0.47 [0.33]; B/F: 0.38 [0.30]; P< 0.001) and significantly higher rates of adherence (PDC≥ 0.80) than B/F initiators (UMEC/VI: n=1004 [25%], B/F: n=1391 [15%]; relative risk: 1.68, 95% CI: 1.57, 1.81; P< 0.001). In the year following initiation, UMEC/VI initiators filled significantly fewer rescue medication canister equivalents than B/F initiators (predicted mean [95% CI]: 1.78 [1.69, 1.88] vs 2.15 [2.08, 2.23]; mean difference [95% CI]: − 0.37 [− 0.50, − 0.24]; P< 0.001), corresponding to 17% less (estimated) rescue medication use (incidence rate ratio [95% CI]: 0.83 [0.78, 0.88]).Conclusion: Among non-exacerbating patients with COPD initiating dual therapy, UMEC/VI demonstrated improved adherence and reduced rescue medication use compared with B/F.Keywords: COPD, LAMA/LABA, ICS/LABA, medication adherence, rescue medication use
